A 28-year-old man with sickle cell disease presents with painless gross haematuria. Imaging shows no stones or mass. Urinalysis shows no casts, no proteinuria. Serum creatinine is normal. Which renal pathology is MOST likely responsible?

• A IgA nephropathy
• B Sickle cell nephropathy with FSGS
• C Renal medullary carcinoma
• D Papillary necrosis from medullary ischaemia ✓

Explanation

Sickle cell disease causes renal papillary necrosis due to sickling in the hypertonic, hypoxic renal medulla, leading to painless haematuria. This is the most common renal manifestation. Distractor B (FSGS) causes proteinuria and progressive CKD, not isolated haematuria. Distractor C (medullary carcinoma) is rare and presents with mass, flank pain, and constitutional symptoms. Distractor A would have synpharyngitic haematuria with possible red cell casts.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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